Alcohol Screening in an Ethnically Diverse Sample of Adolescents in Primary Care

描述（由申请人提供）：在青春期开始经常饮酒的青少年在青春期和整个成年期都有经历严重后果的风险。因此，迫切需要对青少年进行筛查，以确定谁有风险。初级保健（PC）环境提供了一个独特的机会来筛选青少年，因为66%的12-17岁青少年至少每六个月访问一次PC提供者。认识到这一机会，美国医学会指南鼓励提供者通过筛查酒精和药物使用，并在适当情况下提供简短咨询和转诊，将预防服务纳入青少年的常规医疗保健。不幸的是，在这种情况下，大多数青少年没有接受酒精使用筛查；因此，大量有风险的青年从未被发现，也从未得到适当的预防或治疗服务。PC缺乏筛查通常是由于讨论酒精使用时感到不适，培训不足或提供者之间缺乏转诊选择。提供者需要一种易于管理的筛查，不需要大量的时间或培训，可以纳入个人电脑预约，并且可以简单快速地确定青少年的风险水平，以便提供转诊和/或治疗服务。因此，我们正在响应RFA AA-12-08，“对NIAAA儿童和青少年酒精筛查指南的评价”，该指南侧重于青少年的筛查和治疗转诊。在拟议的研究中，我们将在两个州的四个诊所培训PC临床医生（例如护士）使用新的两问题NIAAA筛查指南（NIAAA SG）来确定12- 18岁的不同种族和种族的青少年群体中高危酒精使用的患病率，并测试这种简短筛查的可行性和实用性，以预测随后的酒精使用，酒精风险和其他行为健康问题(例如，大麻使用，性冒险行为，犯罪和行为失常)。我们将NIAAA SG与其他常用的筛查措施（如PESQ-PS、AUDIT和craft）进行比较，以对照DSM滥用或依赖诊断的黄金标准，以确定每种筛查方法作为酒精风险、使用、滥用或依赖预测因子的效用、敏感性和特异性。

DESCRIPTION (provided by applicant): Youth who begin using alcohol regularly during adolescence are at risk of experiencing severe consequences during adolescence and throughout adulthood. Thus, there is a critical need to screen youth to determine who is at-risk. The primary care (PC) setting presents a unique opportunity to screen adolescents, as 66% of 12-17 year old teens visit a PC provider at least once every six months. Recognizing this opportunity, AMA guidelines encourage providers to integrate preventive services into routine medical care for teens by screening for alcohol and drug use and providing brief counseling and referrals where appropriate. Unfortunately, most adolescents are not screened for alcohol use in this setting; therefore, significant numbers of at-risk youth are never identified and never receiv appropriate preventive or treatment services. Lack of screening in PC is often due to discomfort discussing alcohol use, insufficient training or lack of referral options among providers. Providers need a screener that is easy to administer, does not require extensive time or training, can be incorporated into a PC appointment, and that can simply and quickly determine an adolescent's risk level so that referral and/or treatment services can be provided. We are therefore responding to RFA AA-12-08, "Evaluation of NIAAA's Alcohol Screening Guide for Children and Adolescents," which focuses on screening and treatment referral specifically among adolescents. In the proposed study, we will train PC clinicians (e.g., nurses) in four clinics across two states to use the new two-question NIAAA screening guide (NIAAA SG) to determine the prevalence of at-risk alcohol use among an ethnically and racially diverse group of youth age 12- 18, and to test the feasibility and practicality of this brief screener for predicing subsequent alcohol use, alcohol risk and other behavioral health problems (e.g., marijuana use, sexual risk-taking behavior, delinquency and conduct disorder) among this population. We will compare the NIAAA SG to other highly-used screening measures, such as the PESQ-PS, AUDIT and CRAFFT against a gold standard of DSM diagnosis of abuse or dependence to determine each screener's utility, sensitivity and specificity as a predictor of alcohol risk, use, and problems at baseline and six month follow up. We will also compare the utility of these measures in predicting other behavioral health problems, including marijuana use, cigarette smoking, sexual risk-taking behavior, and conduct disorder at both baseline and at six month follow up. An alcohol screening program to identify at-risk youth is of little value if not paired ith treatment. Thus, we go one step further by providing a brief motivational interviewing (MI) intervention as recommended by the NIAAA SG for those youth who are at-risk. This MI intervention called CHAT (a stand-alone term) was specifically developed as a brief intervention (15-20 minutes) that can be integrated and used in PC, and has shown promise in reducing alcohol and marijuana use among youth aged 12-18. We will examine whether alcohol use and problems decrease over a one year period for at-risk youth who receive CHAT compared to at-risk youth who receive usual care. We will also explore whether there is differential effectiveness of the intervention depending upon risk level (i.e., moderate or high).